Provider Demographics
NPI:1902947948
Name:IDEAL PHARMACY INC.
Entity Type:Organization
Organization Name:IDEAL PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISMAT
Authorized Official - Middle Name:ULLAH
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-892-3928
Mailing Address - Street 1:5409 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3112
Mailing Address - Country:US
Mailing Address - Phone:718-439-5900
Mailing Address - Fax:718-439-3697
Practice Address - Street 1:5409 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3112
Practice Address - Country:US
Practice Address - Phone:718-439-5900
Practice Address - Fax:718-439-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0181813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00835245Medicaid
NY3380196OtherNCPDP
NY00835245Medicaid